Lumbar Diskectomy and other spinal techniques require external stabilization of lumbar vertebrae to either side of the vertebra being treated. Traditional pedicle screw insertion has required the identification of the correct insertion point for pedicle screw placement. This process is difficult, even where there is direction visualization of the area of the pedicle where insertion will occur. Because placement, angularity, and turning insertion is a complex process, the insertion process often leads to inaccurate placement of the screw. Such inaccurate placement can have serious neurological, vascular, and dural leak complications.
Further, inaccurate placement of the pedicle screw may result in damage such that screw insertion either cannot be achieved, or if it can be achieved it may require additional surgical procedures for correction and may not enable the holding strength necessary.
Conventional techniques for insertion of the pedicle screw may involve extensive paraspinous muscle dissection, impairment of surrounding tissue and other compromising tissue removal is commonly necessary to properly insert a pedicle screw. This most often results in significant blood loss during this exposure phase of the operation, which is only one part of a multiple step operative procedure. Any problems at any stage of an operation can risk the patient's health and compound any unexpected routine problems which occur.
The surgical practitioner is faced with the choice between high exposure and a good view, versus a more limited exposure with a much poorer view and a heightened risk of a wrong insertion of the pedicle screw. Further, when a high exposure is attempted, excess bleeding is often encountered directly due to the higher exposure which can even further obscure visualization and may require blood transfusion with its associated complications.
Any extra time on the operating table, whether caused by excess bleeding or not places the patient in greater danger. But excess bleeding combined with longer operating time due to poor visibility, and corrective measures required to find the appropriate placement of the pedicle screw can be disastrous. All of the above effects contribute to surgeon fatigue, which can result in increased operative complications.
What is needed is a system which will enable correct placement of a pedicle device, accurately and consistently and which will not require extensive paraspinous muscle dissection in order to obtain the required visual area for proper placement. The needed device will ideally enable a gradual graded introduction into the pedicle and give an earlier indication of problems so that any error can be quickly corrected at a time before the introduction goes any further.
Currently available surgical retractor systems fail to fulfill all of the above requirements. Consequently there is a severe need for structures and procedures to meet such requirement.